Real-world analysis of cost, health care resource utilization, and supportive care in Hodgkin lymphoma patients with frontline failure

Abstract

PurposeThe purpose of this study was to evaluate the economic burden of frontline failure (FLF) among classical Hodgkin lymphoma (HL) patients during and after treatment.Patients and methodsThe population consisted of adult HL patients identified from January 2010 through September 2015 without any other primary cancer prior to HL diagnosis, who also had a frontline (FL) regimen indicative of curative intent. Patients were characterized as FLF (those who restart, switch to any chemotherapy; had a hematopoietic stem cell transplant; or newly initiated radiation therapy [RT] after discontinuing FL) or non-FLF (those not considered as FLF). Direct health care utilization and expenditures were measured over both fixed and variable length follow-up periods and during FL therapy.ResultsThere were 77 FLF and 602 non-FLF patients who met the final inclusion criteria. FLF and non-FLF patients were demographically similar with mean age 38.5 years and 47.5% females. Average per patient per month (PPPM) costs were significantly higher for FLF patients during all follow-up (US$20,266 vs US$7,772, P<0.05). Annual total expenditures were significantly higher among FLF patients (US$198,388) vs non-FLF patients (US$37,549). FLF (vs non-FLF) patients had a significantly shorter duration of FL therapy (116 vs 131 days, P=0.024) and higher total PPPM expenditures during FL (US$29,040 vs US$16,369, P<0.05). Annual cost varied by failure type with those who failed due to restart incurring the highest cost (US$269,189) and those who switched incurring the lowest cost (US$46,951). FLF patients had a significantly greater utilization in every health care resource category during follow-up.ConclusionFLF (vs non-FLF) patients utilized substantially more health care resources and incurred a substantially higher economic burden. Over 5 years, FLF patients with at least two lines of treatment were projected to incur US$535,846 of health care costs. Further research is needed to determine optimal treatment that could reduce the risk of progression, need for treatment after FL, and enhance long-term clinical and economic outcomes.

Real-World Healthcare Resource Utilization in Patients with Classical Hodgkin Lymphoma Treated with Pembrolizumab and Nivolumab in the USA

“…In addition to poor clinical outcomes, patients eligible for treatment with pembrolizumab or nivolumab have a substantial economic burden. In a real-world study of patients with relapsed cHL (including 39% with prior stem-cell transplant), utilization of inpatient, emergency room (ER), and laboratory and radiology service was significantly higher compared to patients without relapsed cHL (i.e., proportion of patients who had an inpatient admission: 66.2% vs. 17.4%, P < 0.001; ER visit: 49.4% vs. 21.1%, P < 0.05; laboratory and radiology service: 100.0% vs. 93.4%, P < 0.05; and pharmacy prescription: 90.9% vs. 82.7%, P > 0.05) [ 18 ]. Additionally, Yasenchak et al conducted a cost analysis among patients with cHL and found that each subsequent line of therapy (LOT) was associated with higher total healthcare costs (from $21,956 in LOT1 to $77,219 in LOT2, and $59,442 in LOT3) and even higher total healthcare costs (total cost per LOT increased seven- to eightfold compared to LOT1) among patients who received a stem cell transplant [ 19 ].…”

“…In addition to a poorer prognosis, relapsed cHL is also associated with higher healthcare resource utilization (HRU) and healthcare costs, with added costs for each additional line of therapy required [18,19]. While both nivolumab and pembrolizumab have been associated with promising clinical period) spanned from the index date up to the end of continuous clinical activity (defined as consecutive quarters with one or more pharmacy claim) or data availability, whichever occurred first.…”

Real-world costs of illness of Hodgkin and the main B-Cell Non-Hodgkin lymphomas in France

“…Five studies were found in North America and one in Europe. American studies were focused on HL, DLBCL or FL patients according to special treatments or line of treatments [14][15][16][17][18] . Moreover, the healthcare system in the US or Canada is considerably different than the French healthcare system especially because of health care organization, reimbursement conditions and different unit prices used to value healthcare resources which makes harder the comparison between studies.…”

“…It allows to assess the impact, in real-life, of healthcare management and to guide health authority in their public decisions. Nevertheless, only a few studies assessing the cost of lymphoma in real-world settings were found in Europe 13 or in North America [14][15][16][17][18] . They were focused on special treatments, particular line of treatments or AEs and they did not finely describe cost components of the active treatment phase.…”

Effect of Integrated Ayurveda and Yoga Therapy (IAYT) on remission management of non-Hodgkin lymphoma: A single case study

“…Patients desperate for long term health care are down with economic burden which increases considerably at onset and later stages of this condition (2). Cost of the treatment also includes supportive care and alternative techniques used (3). Diagnosis and treatment of cancer is always manifold with numerous side effects.…”